Anamnesa HIV

Resiko terjangkitnya HIV atau

penyakit menular seksual.
Kenapa anda curiga terjangkit HIV?
Seksual Jika berhubungan seksual apakah anda menggunakan pelindung atau
tidak?
Apakah anda berhubungan dengan laki-laki atau perempuan?
Pemakaian suatu substansi
Apakah anda pernah menggunakan jarum suntik? Apakah anda suka
berganti-gantian jarum suntik?
Okupasi Apakah pekerjaan anda beresiko terkena cairan tubuh?
Tato Apakah anda memiliki tato?
Apakah menggunakan jarum yang steril?
Past Medical and Surgical History
Penyakit Kronis Apakah anda memiliki suatu keadaan yang kronis? Seperti diabetes,
tekanan darah tinggi, penyakit jantung, masalah kolesterol, asma dan
lainnya?
Jika ya, apa anda mendapat pengobatan?
Riwayat Penyakit Sebelumnya Apakahg anda pernag dirawat dirumah sakit? Kapan? Karena alasan
apa?
Hepatitis Apa anda pernah menderita penyakit hepatitis? Hepatitis tipe apa?
Infeksi Menular Seksual Apakah anda pernag mendapat pengobatan untuk :
Sifilis? Vaginitis? Herpes gential? Gonorrhea? Klamidia? Atau penyakit
seksual lainnya?
Pola Hidup Apakah anda merokok? Sudah berapa lama anda merokok? Jenis apa?
Berapa banyak dalam sehari?
Apa anda minum alkohol?
Imunisasi Kapan terakhir anda mendapat vaksinasi? Vaksinasi jenis apa?
Sensitive Sexual History Questions
General Sexual Do you have sex with men, women, or both?
In the past, have you had sex with men, women, or both?
Sexual Practices Do you have anal, vaginal, and/or oral sex?
Do you protect yourself from sexually transmitted infections, or HIV
reinfection? How?
Prevention Do you know the HIV status of your partner(s)?
Do you protect your partners from HIV? How?
In what situations do you or your partner use condoms or some other
barrier?




Table 3. Review of Systems
For each positive answer, document location, characteristics, duration of symptoms, and exacerbating
and alleviating factors.
General
General Do you ever wake up feeling tired?
Fever Do you have fevers? How high, and for how long?
Night Sweats Do you ever sweat so much at night that it soaks your sheets and nightclothes?
Chills Do you experience shaking or teeth-chattering when you feel cold?
Anorexia How is your appetite?
Weight What was your weight 1 year ago?
What is a normal weight for you?
Have you lost or gained weight unintentionally?
Body Changes Have you noticed any changes in the shape of your body (describe)? For example,
has there been an increase in your waist, collar, or breast size or a decrease in your
arm, leg, or buttocks size?
Have you noticed thinning of your face?
Head, Ears, Eyes, Nose, and Throat
Vision Have you noticed any changes in your vision, especially blurred vision or vision loss,
double vision, new "floaters" or flashes of light?
Have you noticed this problem in one or both eyes?
When did you first notice these changes?
Mouth, Ears, Nose,
Throat
Have you noticed any white spots in your mouth or a white coating on your tongue
(thrush, oral hairy leukoplakia)?
Do you ever get sores in your mouth or the back of your throat? Gum problems?
Any nosebleeds?
Hearing loss, ringing in your ears, ear pain?
Cardiovascular
Cardiac Any palpitations or chest pain?
Any shortness of breath during activities or while you are lying down?
How far can you walk or run before you get short of breath?
Any swelling in feet or hands?
Pulmonary
Cough Do you have a cough?
Can you describe it? Dry or productive, amount, color, odor, presence of blood in
sputum? When is it the worst?
Dyspnea Do you ever feel short of breath?
Does that happen when you are sitting still, lying down, or moving around?
How severe is your shortness of breath?
Does it prevent you from doing anything?
Do you ever wheeze?
Gastrointestinal
Dysphagia Do you have any problems with food sticking in your throat or being difficult to
swallow?
Do you notice it's easier to swallow liquids or solids?
Do you gag or get nauseated when trying to eat?
Odynophagia
Do you have pain in your throat, esophagus, or behind your breastbone when you
swallow?
Nausea/Vomiting Do you have nausea or vomiting?
When? Are there specific things that cause this?
Dyspepsia/Reflux Do you ever have heartburn?
When does it happen--after eating, lying down, on an empty stomach?
Do you get the taste of stomach acid in your mouth?
Diarrhea Do you have diarrhea, or more than 3-5 unformed stools a day?
Stool characteristics: bloody, pus, mucus?
Pain or cramping with diarrhea? Tenesmus?
Bowel Habits How frequently do you have bowel movements?
Do you have problems with constipation, blood in the stools, or other?
Do you have problems with flatulence or belching after eating?
Genitourinary
Genital Do you have any lesions or sores on your genital area now, or have you in the past?
Have you ever had genital herpes? If yes, how often do you have outbreaks?
When was the most recent outbreak?
Women Have you had any lower abdominal pain?
Have you noticed a vaginal discharge or odor?
Do you have any burning or pain on urination?
Frequent urination?
Do you lose control of your urine or have problems getting to the bathroom before
you start to urinate?
Men Have you noticed any swelling or testicular pain?
Do you have difficulty starting your stream of urine?
Are you getting up at night to urinate?
Have you had burning or pain on urination?
Do you lose control of your urine or have problems getting to the bathroom before
you start to urinate?
Have you ever had kidney stones?
Do you have any difficulty developing an erection or maintaining one?
Any discharge from your penis?
Musculoskeletal

Do you have any muscle aches or pains?
Back pain, joint pain, and/or swelling?
Have you ever broken any bones?
Do you have chronic pain?
Describe the pain--location, duration, rating (scale of 1-10), alleviation factors.
Skin
Herpes Zoster Have you ever had chickenpox (varicella)?
Have you ever had "shingles" (zoster)?
Where were the lesions?
Tinea
Do you have fungal infections on your skin, especially groin, fingernails, toenails, or
feet?
Folliculitis Do you have any itchy bumps on your face, back, or chest?
Seborrhea Do you have flaking or itching on your skin or scalp?
Skin Lesions Have you noticed any rash or skin problems? If so, where?
Have you noticed any new moles, bruises, or bumps on your skin?
Do you have any moles that changed shape, size, or color?
Neurologic
Headache How often do you get headaches?
Describe the headaches--location, timing, duration, alleviating or aggravating factors.
Do they cause nausea or vomiting?
Does sensitivity to light lead to headaches?
Memory Do you have difficulty with your memory or ability to concentrate? If so, describe.
Gait Have you noticed any changes in the way you walk?
Neuropathy Do you have any numbness, tingling, burning, or pain in your hands or feet?
Seizures Have you ever had a seizure or "fit"?
If so, describe the seizure--When? How long did it last? Loss of consciousness? Was
medical care sought?
Weakness Do you have or have you had any weakness in your arms or legs?
Endocrine
Diabetes Have you had any increase in thirst, hunger, or urination?
Thyroid Have you noticed changes in your energy level?
Do you have intolerance to heat or cold?
Have you noticed changes in your hair (thinning, coarse texture)?
Sex Steroids Have you noticed any changes in your libido?
Hematologic/Lymphatic
Adenopathy Do you have swollen glands?
If so, describe--location, painful, size if measurable.
Bruising or Bleeding Have you noticed easy bruising or prolonged bleeding after injury?
Nosebleeds or bleeding gums?